Bilateral Buttock Lipo-Augmentation (BBL) Sydney

A Bilateral Buttock Lipo-Augmentation (BBL) is the term applied to two operations – a combination of Liposuction and fat transfer operations.

Dr Dona has spent over 15 years in private practice refining these surgical procedures, including learning techniques with BBL surgeons in Miami.

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Dr Eddy Dona has been a specialist plastic surgeon since 2007, and is a member of the Australian Society of Plastic Surgeons. From your first clinic visit, and throughout your surgical journey, Dr Dona and his team will be there to make it as smooth as possible.
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A Bilateral Buttock Lipo-Augmentation (BBL) is based on fat grafting, which involves removing a patient’s own fat from one part of the body and re-implanting it where it’s needed – in this case, the buttocks.

It is injected in the butt to:

  • Add volume.
  • Enhance shape and roundness.
  • Lifting the buttocks by adding more volume to the upper and outer aspects.


Learn More About Bilateral Buttock Lipo-Augmentation (BBL) Surgery




During your consultation at our Sydney clinic, Dr Dona will assess your body to ensure you are healthy and technically suitable to have a BBL. The key to being a good candidate for the BBL is to have an adequate amount of fat in other areas of your body. A thin person with no excess fat is not suitable for these procedures. Dr Dona will also ensure you have realistic expectations about your surgery, post-operative course and likely results.

Preparation for BBL surgery

All patients that book surgery will be provided with pre and post-operative guidelines by our clinic so you can be fully prepared.

Any person undergoing any surgery needs to be fit and healthy and have realistic expectations of the potential results. Also, you must be fully aware of all the potential complications and risks associated with the chosen operation.

For a BBL, you must not smoke (and no nicotine replacements) for a month prior to surgery and for at least two months after surgery. Smoking increases the risk of complications and decreases the chances of success of the surgery. Patients should avoid taking Aspirin or any other blood thinner unless otherwise indicated by the surgeon.

You need to ensure you have prepared your home and support person/s to have a smooth post-operative course. This will optimize your chance to fully rest and recover properly. A ride to and from the procedure should be arranged as well as someone to stay with you for at least the first 24 hours (ideally one week!).

Compile a checklist of things that must get done before surgery and things you’ll need/want during your recovery. Prepare a comfort area with extra blankets and pillows. Extra towels laid on the sleeping area will prevent staining of the sheets.

Bilateral Buttock Lipo-Augmentation Procedure

A BBL is performed under a general anesthetic in a hospital typically as a day surgery procedure. Depending on the amount of liposuction required, the entire procedure can take anywhere from 2 – 4 hours. The BBL is actually a two-stage surgical procedure:

Stage 1: During stage 1 of the surgery, fat is liposuctioned from areas of the body where it is in excess. The typical areas include the thighs, abdominal wall, lower back and mid-back. This provides the added benefit of removing excess fat from other parts of the body, typically reducing the waistline to further accentuate the buttocks.  The fat removed via liposuction is then processed and purified, and the second stage of the surgery begins.

Stage 2: This stage of the procedure involves injecting of the patient’s own fat back into the buttocks, where it is shaped, making the buttocks larger and rounder. Once the appropriate amount of fat is injected, the procedure is complete.


A BBL is a procedure to enhance your form by relocating fat from less wanted places to more needed places – the buttocks.


Frequently Asked Questions

Do I have other surgical options for a bigger butt?

Other options are available for buttock enhancement surgery.

Bilateral Buttock Augmentation with Implants

The use of silicone implants for buttock augmentation has been around for many years. Unlike breast implant surgery, Buttock implant surgery is associated with very high complication rates and therefore many surgeons do not perform them. Dr Dona does not offer buttock implant surgery.

Bilateral Buttock Lipectomy (Lift) Surgery

A buttock lift is a skin-tightening procedure which eliminates loose, hanging skin from above the buttocks, which elevates the typically low hanging buttock tissues to improve the shape and tightness of the entire buttock.

Patients who have loose skin above their buttocks are the best candidate for this procedure. Patients who have undergone massive weight loss are typical candidates for this surgery. The extra skin must be surgically removed to get the best lift.

For this buttock lift technique, an ellipse of skin and fat is excised from the upper part of the buttock at the junction with the lower back.  After this skin is excised, the skin is sutured back together so that there is no loose skin above the buttocks and the buttocks are lifted. This allows for a true elevation of the buttock tissues and a reshaping of the entire buttock.

In order to remove the excess skin and tissue, a scar will appear where the skin is joined back together. It is similar to an abdominoplasty surgery but involving your butt.

Note: This is a very different procedure from the BBL, which alters the buttocks by injecting your own fat into the buttocks – no skin is removed.

How much fat can you inject?

The amount of fat that can be injected into each buttock cheek can vary from 400ml up to 2000ml! However, most surgeons would typically use no more than 1000ml per cheek.

Whilst it is tempting to think that more is better, this is not quite true.

A number of factors determine how much fat is injected. These include:

  • How much is available
  • How much is wanted/needed
  • The tightness/looseness of the skin and buttock tissues

Unfortunately, the more fat that’s injected, the greater the percentage of fat that does not survive. Therefore it becomes counterproductive and increases the potential complications if too much fat is injected. The best analogy is if you place a few plant seeds in a small pot of soil. If you sow a small number of seeds, all are likely to germinate and survive/sprout. If a very large number of seeds are placed in that small pot of soil, many of them will die and only a smaller percentage will survive/germinate. There is a limit to how many seeds will survive and grow within a limited space.

How much of the transferred fat survives?

This is a highly controversial question and many surgeons will provide conflicting answers. Numerous factors affect how much of the fat will survive, and therefore contribute to a long lasting result. These include:

  • Surgical technique for the liposuction
  • Fat processing technique
  • Fat re-injection technique
  • Fat volume injected
  • Patients general health
  • Smoking
  • Patients’ compliance with post-operative instructions
  • Unknown!

What all surgeons agree on is that a substantial percentage of the fat that is re-injected does NOT survive. The figures used varies anywhere between 20-50%. However, whatever is left after 3-6 months has survived and is permanent.

Can you have other surgical procedures with a BBL?

A BBL can take up to 4 hours to perform. In addition to this, the requirements to avoid sitting and restricted sleeping positions makes it highly undesirable to have any other surgical procedures at the same time as your BBL. Doing so significantly increases the risks of potential complications and compromises the potential results of your BBL and the associated other procedure.

Therefore, Dr Dona will typically not perform any other operation, such as an abdominoplasty (Tummy Tuck) or Breast Augmentation at the same time as your BBL surgery.


Your recovery – what to expect after your BBL surgery in Sydney

Immediately after surgery, your buttocks will be large and swollen.  All the fat that has been injected will be there, and you will be very swollen from the surgery itself.

You will feel sore and bruised in all the areas that had liposuction, and in your buttocks.

After 2 – 4 weeks the initial swelling will go away, and a significant amount of the buttock size will be lost.  Then over the next 3 months, fat which has not survived the procedure is slowly cleared out of the body. So, it is at least three months before you get your final results.

Following the surgery, you will be placed in a compression garment that will help the healing process and support areas that underwent liposuction and the buttocks. This is to be worn for at 6 weeks.

You should be up and walking the day following your surgery.

You should avoid putting much weight on your buttocks for a few weeks following the procedure. In fact, avoiding sitting directly on your buttocks for lengthy periods of time for a full six weeks. The pressure could displace the fat or cause more of it to not survive and be absorbed. If you must sit, you should sit on a padded or cushioned surface, and not on hard surfaces. We recommend you purchase a boppy pillow to use for the first few weeks for those times when you must sit down. When sitting, try leaning forward to have your weight placed on your upper thighs, rather than your buttocks.

In order to take direct pressure off the bottom, you should avoid sleeping on your back. Ideally you should sleep on your stomach or on your sides.

You should be able to return to work, assuming it is not a job that involved rigorous physical activity, after 2 weeks. On average, one should wait around one month to begin to feel normal, two months before returning to exercise, and three-six months to see final results.

What Happens At My First Clinic Appointment?

Leave your dressings intact until your first post-operative appointment. Generally speaking, your first appointment will be scheduled no later than the day following your hospital discharge. Within your first post-operative appointment, one of our friendly and caring post-operative nurses will inspect your wounds and administer light therapy treatment, aimed at optimizing your recovery. Our post-operative nurses will continue to see you, at least three times per week for the following few weeks, and of course, will be available to answer any questions in-between your in-clinic appointments.

Going To The Toilet After A BBL (Bloating And Constipation)

It is very common after surgery to experience bloating and constipation. This is because you have just had surgery and therefore you will be less mobile. In addition, you will be provided with strong pain medication which causes slowing of the bowels. You will be encouraged to consume plenty of fluids, maintain a high-fiber diet, along with some gentle laxatives (such as Movicol), to help restore your normal bowel habits.

Reducing The Risk Of Blood Clots (DVT’s) 

Every surgical patient is at increased risk of developing blood clots in their legs. Therefore, we undertake a number of measures during your surgery to reduce the risk of these.

During your recovery you are encouraged to do foot exercise such as tapping your feet or wriggling your toes. This is designed to activate your calf muscles and encourage blood flow and is another vital measure to help reduce the risk of blood clots.

Mobilising regularly and remaining well hydrated at all times is also recommended.

How long until you have the final results?

Like many operations, it takes a while to achieve the final results from surgery. You will need to wait at least three months, and ideally up to six months to fully appreciate your new buttocks.


What are the possible complications?

More information on general potential complications can be found on our site. LEARN MORE 

The potential complications of a BBL procedure include all the complications associated with liposuction combined with all the complications associated with fat transfer. Dr Dona will go through these in detail with you during your consultation and provide detailed written information regarding the same.

However, whenever someone is having an anaesthetic, no matter what it’s for, then things can potentially go wrong. That is why no surgery should be considered “minor”. Of course, whilst the chances of the following potential problems occurring are extremely small, you still need to know about them.

General Potential Complications:

  • Anaesthetic issues – which can affect heart, lungs or cause strokes
  • Allergic reactions – This can be very mild to life threatening.
  • Clots
    • Superficial vein clots, which is a complication of the cannula or drip that’s placed in your vein
    • Deep vein clots – these can potentially spread to the lung and be life threatening. We do several things during surgery and after surgery whilst you’re in hospital to minimise the risk of you developing these.
  • Wound problems – such as infection and breakdown
  • Bleeding – early or late
  • Death – whilst the chances of this is exceeding rare, any of the previous issues can result in this devastating complication.

All these potential problems are standard for any operation, although some operations and some patients have an increased risk of developing them.

Specific Potential Complications:

  • Dimpling/Irregularity
  • Skin Sensory Changes
  • Skin Necrosis
  • Fat necrosis
  • Lumpiness
  • Stretch Marks
  • Inadequate shape
  • Dissatisfied with size
  • Asymmetry
  • Damage to deep muscles
  • Damage to deep nerves
  • Seromas
  • Skin discoloration
  • Need for revision surgery and the associated costs.
  • Chest problems – pneumothorax; pneumonia; pulmonary embolus; fat embolus
  • Death – BBL surgery has a notorious reputation as being the highest risk cosmetic surgery procedure for this devastating complication. Fat embolus is thought to be the cause of this specific complication.

Find out more


Learn more about our procedures or schedule a one-on-one consultation at our Sydney clinic

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